Abstract: A catheter adapted or high density mapping and/or ablation of tissue surface has a distal electrode array with offset spine loops, each spine loop having at least a pair of linear portions and a distal portion connecting the pair of linear portions, and one or more electrodes on each linear portion. The linear portions of the plurality of offset spine loops are arranged in-plane a single common plane, and the distal portions of the plurality of offset spine loops are arranged off-plane from the single common plane.

Abstract: A method for ablating tissue by applying at least one pulse train of pulsed-field energy. The method includes delivering a pulse train of energy having a predetermined frequency to cardiac tissue, the pulse train including at least 60 pulses, an inter-phase delay between 0 ?s and 5 ?s, an inter-pulse delay of at least 5 ?s, and a pulse width of 5 ?s.

Abstract: A method for treating a sinus cavity is provided. The method includes the steps of inserting a plasma applicator into a sinus cavity defined in a bone mass, positioning the plasma applicator adjacent a tissue formation, generating a selectively reactive plasma effluent at the plasma applicator and directing the selectively reactive plasma effluent at the tissue formation. The selective nature of the reactive plasma enables treatment of specific targets inside the sinus while minimizing the effect on other tissues. Such treatment includes, but not limited to, sterilization of bacterial colonies, vaporization of unwanted tissues or foreign masses, stimulation of tissues by enriching the content of reactive oxygen and nitrous oxide pathways, and combinations thereof.

Abstract: This disclosure is directed to a catheter having a dual node multiray electrode assembly at the distal end of the catheter body. The dual node multiray electrode assembly includes a proximal multiray array with a plurality of spines connected at one end, each spine having at least one ablation electrode, and a distal node. The dual node multiray electrode assembly may have an expanded configuration and a collapsed configuration wherein the spines are arranged generally along a longitudinal axis of the catheter body. The distal node may be configured to be deployed within a vessel and the proximal multiray array may be configured to engage tissue forming an ostium of the vessel with the ablation electrodes. In some embodiments, the relative distance between the proximal multiray array and the distal node is adjustable.

Abstract: A desiccation device for operation on a target tissue includes a handle, a shaft extending distally from the handle, and a head. The shaft defines a lumen therethrough, and the head has a loop configuration supported on a distal end of the shaft. The head is hollow and defines a lumen therethrough. The lumen of the head is in fluid communication with the lumen of the shaft. At least a portion of the head is electrically connected to a source of electrosurgical energy. A fluid is circulatable through the lumens of the shaft and the head.

Abstract: This disclosure is directed to a catheter having a dual node multiray electrode assembly at the distal end of the catheter body. The dual node multiray electrode assembly includes a proximal multiray array with a plurality of spines connected at one end, each spine having at least one ablation electrode, and a distal node. The dual node multiray electrode assembly may have an expanded configuration and a collapsed configuration wherein the spines are arranged generally along a longitudinal axis of the catheter body. The distal node may be configured to be deployed within a vessel and the proximal multiray array may be configured to engage tissue forming an ostium of the vessel with the ablation electrodes. In some embodiments, the relative distance between the proximal multiray array and the distal node is adjustable.

Abstract: A robotic surgical system including a control circuit configured to: (i) generate an energy control signal to deliver an electrosurgical energy signal to a first electrode and a second electrode, (ii) measure a current supplied and a voltage applied to the first and second electrodes, (iii) calculate impedance based on the measured current and voltage, (iv) compare the calculated impedance to a predetermined impedance level, (v) generate a subsequent energy control signal to deliver a subsequent electrosurgical energy signal to the first and second electrodes, when the calculated impedance is less than the predetermined impedance level, by adjusting at least one energy signal characteristic between the delivered electrosurgical energy signal and the subsequent electrosurgical energy signal based on the calculated impedance, and (vi) generate a drive control signal to activate a blade when the calculated impedance is greater than or equal to the predetermined impedance level.

Abstract: This disclosure is directed to a catheter having a dual node multiray electrode assembly at the distal end of the catheter body. The dual node multiray electrode assembly includes a proximal multiray array with a plurality of spines connected at one end, each spine having at least one ablation electrode, and a distal node. The dual node multiray electrode assembly may have an expanded configuration and a collapsed configuration wherein the spines are arranged generally along a longitudinal axis of the catheter body. The distal node may be configured to be deployed within a vessel and the proximal multiray array may be configured to engage tissue forming an ostium of the vessel with the ablation electrodes. In some embodiments, the relative distance between the proximal multiray array and the distal node is adjustable.

Abstract: A method, consisting of ablating tissue for a time period, measuring a contact force applied during the time period, and measuring a power used during the time period. The method further includes ceasing ablating the tissue when a desired size of a lesion produced in the tissue, as estimated using an integral over the time period of a product of the contact force raised to a first non-unity exponent and the power raised to a second non-unity exponent, is reached.

Abstract: A catheter device provides a balloon structure and a side-firing laser lumen within the balloon to create lesions in the pulmonary vein (PV) in the treatment of atrial fibrillation. Mounted on the balloon so as to contact the PV when the balloon is inflated are one or more electrodes which may be used in a measurement mode, a treatment mode, or both.

Abstract: A catheter system can include an electrical adapter and a catheter. The electrical adapter includes a hollow adapter body having a longitudinally extending channel and an electrical terminal positioned within the channel. The electrical adapter can be configured to connect to an energy source. The catheter can include an elongated body having a proximal end portion and a distal end portion, and an electrical connector coupled to the proximal end portion. The electrical connector forms the outer periphery of the catheter along a portion of the longitudinal length of the catheter. The electrical terminal and the electrical connector contact each other when the electrical connector is advanced through the channel to an electrical contact position in the channel, and are isolated from each other when the electrical connector is proximal of the electrical contact position.

Abstract: The invention relates to tissue scissors (10) with improved stability and improved handling that have two structurally and electrically different branches (11, 12). While the sliding surface (25) of the first branch (11) has a metal-ceramic hard material layer (30), such as, for example, titanium nitride, the second sliding surface (34) of the second branch (12) has an electrically non-conductive ceramic layer (33). The material mating produces great mechanical resistance to abrasion in the bearing (17) and on the cutting edges (28, 35). At least one of the branches, in particular branch (12), can have a cermet body (36) to improve the cooling of the cutting edge (35 (28)) and/or keep it sharp, to prevent heating of the branches (11, 12) during coagulation and sticking of the tissue.

Abstract: A medical electrical lead and methods of implanting medical electrical leads in lumens. Leads in accordance with the invention employ preformed biases to stabilize the lead within a lumen and to orient electrodes in a preferred orientation.

Abstract: The present invention provides a controlling apparatus for a skin resurfacing device performing a surgical procedure on a human skin with a surgical needle, including: a controller 20; a voltage regulator 50 configured to regulate a voltage supplied to the skin resurfacing device from a power supply 10 according to a control of the controller; and a starting switch 80 configured to turn on/off a supply of power between the voltage regulator and the skin resurfacing device, in which the controller controls the voltage regulator so as to output a preset jump start voltage to the skin resurfacing device every time the starting switch is turned on, if a jump start function that is a function of starting the skin resurfacing device is set by a starting voltage when an operating voltage of the skin resurfacing device is lower than the starting voltage of the skin resurfacing device at the time of the surgical procedure.

Abstract: An optical coupler is disclosed for mounting at a distal end of an optical imaging device for visualizing a surface area covered with an opaque fluid and/or particulate matter. The coupler includes a visualization section at one end of the coupler and an attachment section connected to and extending away from the visualization section. The attachment section is dimensioned to be mounted at the distal end of the optical imaging device. The visualization section includes a proximal surface for engaging the distal end of the optical imaging device. The visualization section includes an outer surface spaced apart from the proximal surface. The outer surface extends continuously from a first outer side boundary across to a second opposite outer side boundary of the visualization section. The visualization section may include a hollow instrument channel extending from the proximal surface toward the outer surface.

Abstract: According to some embodiments, a medical instrument (for example, an ablation device) comprises an elongate body having a proximal end and a distal end, an energy delivery member positioned at the distal end of the elongate body, a first plurality of temperature-measurement devices carried by or positioned within the energy delivery member, the first plurality of temperature-measurement devices being thermally insulated from the energy delivery member, and a second plurality of temperature-measurement devices positioned proximal to a proximal end of the energy delivery member, the second plurality of temperature-measurement devices being thermally insulated from the energy delivery member.

Abstract: A method and systems for treating chronic total occlusions, particularly those that are difficult to treat, is disclosed. hi this approach, recanalizing the CTO is achieved using a combined antegrade and retrograde approach. The proximal end of the occlusion is penetrated using an antegrade wire, using a traditional approach. Using collateral vessels, the distal end of the occlusion is crossed in a retrograde fashion. By appropriately maneuvering each member and applying radiofrequency energy between the proximal and distal ends of the occlusion, a continuous channel is created.

Abstract: A device and method for determining ablation electrode to tissue contact to assess the effectiveness of an ablation procedure by determining the effect of saline irrigation on catheter tip temperature.

Abstract: A method and system for automated and semi-automated predictable, consistent, safe, effective, and lumen-specific and patient-specific cryospray treatment of airway tissue in which treatment duration is automatically set by the system following entry of patient information and treatment location information into the system by the user, and treatment spray is automatically stopped by the system when the automatically selected treatment duration has been achieved as determined by the system.

Abstract: A method and device for determining the transmurality and/or continuity of an isolation line formed by a plurality of point contact ablations. In one embodiment, a method for determining the size of a lesion (width, depth and/or volume) is disclosed, based on contact force of the ablation head with the target tissue, and an energization parameter that quantifies the energy delivered to the target tissue during the duration time of the lesion formation. In another embodiment, the sequential nature (sequence in time and space) of the ablation line formation is tracked and quantified in a quantity herein referred to as the “jump index,” and used in conjunction with the lesion size information to determine the probability of a gap later forming in the isolation line.

Abstract: Methods are disclosed for delivering energy to a body of a human or animal during a treatment procedure using an electrosurgical generator, a pre-set overall procedure time being defined for the treatment procedure, a ramp time being defined for a parameter to reach a pre-set threshold during the treatment procedure, the method comprising: measuring the parameter over time; and if the parameter has not substantially reached the pre-set threshold by the ramp time, setting a procedure extension time responsive to the time difference between the ramp time and the time at which the pre-set threshold was reached, and extending the overall procedure time by the procedure extension time.

Abstract: Various technologies for cartilage harvesting are provided. Some of the technologies include a method including coupling a cutting head onto an actuator; applying a force to the cutting head via the actuator; and cutting a cartilage with the cutting head based on the force. Some of the technologies include a method including coupling an adapter to a rotary tool, wherein the adapter adapts the rotary tool from a rotary power to an impact power; coupling a cutting head to the adapter; applying a force to the cutting head via the adapter; and cutting a cartilage with the cutting head based on the force. Some of the technologies include a device including a cutting head hosting a plug that is able to travel within the cutting head. Some of the technologies may include an extracted chondrocyte including a sidewall inclined from about five degrees to about twenty five degrees.

Abstract: An end effector includes first and second jaws, first and second buttresses, and an ultrasonic blade. The first jaw includes a fastener cartridge having a first tissue contacting surface and a plurality of fasteners arranged in rows parallel to a longitudinal axis of the first jaw. The first buttress is attached to the first tissue contacting surface and the second buttress is attached to a second tissue contracting surface of the second jaw. The first and second jaws are movable relative to one another and are configured to grasp tissue therebetween. The ultrasonic is activatable to weld the first buttress to the second buttress and to subsequently cut the welded first and second buttresses and tissue grasped between the first and second jaws.

Abstract: Medical methods and systems are provided for effecting lung volume reduction by selectively ablating segments of lung tissue.

Abstract: A vapor sensor comprises a housing with an inlet opening in fluid communication with a sensor element within the housing. Standoff member(s) are positioned to maintain a gap between the inlet opening and a skin site. An operating circuit is in electrical communication with the sensor element and communicatively coupled to an output member. In use, the output member generates a sensory output indicative to an operator regarding concentration of alcoholic vapor in the ambient atmosphere proximate the skin site upon receiving communication from the operating circuit.

Abstract: A catheter with a spring tip that facilitates atraumatic initial placement and also continues to protect tissue contacted by the catheter device subsequent to the initial placement. The spring tip is shock-absorbing and axially compliant and allows enhanced use of various devices in conjunction with the tip such as bioptomes, electrodes, needles, flushing catheters, delivery catheters, and the like. The atraumatic shock-absorbing tip could include conductive or non-conductive materials.

Abstract: Aspects of the present disclosure are presented for a single surgical instrument configured to grasp, seal, and/or cut tissue through application of therapeutic energy, and also detect nerves through application of non-therapeutic electrical energy. A medical device may include two jaws at an end effector, used to apply therapeutic energy and to perform surgical procedures. The therapeutic energy may be in the form of ultrasonic vibrations or higher voltage electrosurgical energy. One of the jaws may be configured to cut tissue through application of the blade. In addition, one or both of the two jaws may be configured to apply nontherapeutic energy for nerve stimulation probing. The application of therapeutic energy may be disabled while the nontherapeutic nerve stimulation energy is applied, and vice versa. The nontherapeutic nerve stimulation energy may be applied to the use of one or more probes positioned near one or both of the jaws.

Abstract: An electrosurgical ablation apparatus for generating and emitting electromagnetic radiation energy for ablating biological tissue is disclosed. The apparatus comprises an operating unit (1), a handheld applicator unit (3) with an applicator antenna (4) and a cable connection (2) between both. The applicator antenna (4) is a dual or multi-resonant ablation antenna (41a, . . . 41d) for transmitting microwave ablation energy at at least two different frequencies which are selected especially according to the electrical properties and dimensions of the tissue to be ablated.

Abstract: Electrosurgical methods and systems. At least some of the illustrative embodiments are methods including maintaining plasma proximate to an active electrode in a first energy range, and a second energy range. During periods when plasma is proximate to the active electrode, the illustrative method may include controlling flow of fluid drawn into an aperture of an electrosurgical wand, and in some situations increasing fluid flow drawing into the aperture responsive to the active electrode being in operational relationship with tissue, and in other cases decreasing fluid flow drawing into the aperture responsive to the active electrode being in operational relationship with tissue. Further, during periods when plasma is proximate to the active electrode, the illustrative method may include providing output energy at a default energy setpoint, and then providing output energy at a second energy setpoint.

Abstract: The present disclosure discusses a system and methods for a deep brain stimulation lead. More particularly, the disclosure discusses a stimulation lead that includes one or more silicon based barrier layers within a MEMS film. The silicon based barrier layers can improve device reliability and durability. The silicon based barrier layers can also improve adhesion between the layers of the MEMS film.

Abstract: A method for the treatment of a patient for the purpose of lowering blood pressure and/or treating other medical conditions such as cardiac arrhythmias. A catheter having an ablation element is placed inside the body of a patient and is directed to a targeted location either on in the abdominal aorta where the right or left renal arteries branch from the aorta at or near the superior junction or ostia or on the inside of the inferior vena cava near the junction with the right renal vein or in the left renal vein at a position spatially near where the left renal artery branches from the abdominal aorta. Catheters designed for use in the method where these targeted locations are also disclosed and claimed.

Abstract: A method includes providing a bipolar energy source, a monopolar energy source, a bipolar assembly, and a monopolar assembly. The method further includes moving the monopolar assembly to a retracted position. Moving the monopolar assembly to the retracted position couples the bipolar energy source to the bipolar assembly and decouples the monopolar energy source from the monopolar assembly. The method further includes moving the monopolar assembly to a deployed position. Moving the monopolar assembly to the deployed position decouples the bipolar energy source from the bipolar assembly and couples the monopolar energy source to the monopolar assembly.

Abstract: A medical device for treating an LAA is presented. The device includes a cap, a bulb and a joint assembly therebetween. The cap is a three layer mesh structure with a retaining hub securing the layers together. A plurality of proximal wire loops extend from the base layer to a proximal post of the joint assembly. The bulb has a plurality of distal wire loops that extend between a terminal post and a distal post of the joint assembly. The joint assembly comprises a first ball joint, a second ball joint and a housing. Each ball joint is retained in the housing independent ball and socket relationships. Each ball joint and post defines a longitudinal axis. The housing defines a housing longitudinal axis. By way of the ball and socket relationship each ball joint longitudinal axis may form an angle of between about 0 to about 35 degrees with the housing longitudinal axis in any direction.

Abstract: A treatment system includes a power source for heat generation which outputs power for heat generation, a grasping member having a heating element which applies the power for heat generation as thermal energy to a grasped living tissue and is disposed at a grasping surface, and a control section which repeats a first control mode of performing control such that the heating element reaches a first temperature and a second control mode of performing control such that the heating element becomes lower than the first temperature, and controls the power source for heat generation according to a temperature change parameter based on change in temperature of the heating element in the first control mode or the second control mode so as to end application of the thermal energy.

Abstract: A fluid delivery catheter configured to allow optimal fluid distribution through each electrode by varying the diameter of a catheter lumen is disclosed. Uniform or different fluid flow rates through longitudinally spaced apart elution holes may be achieved. Exemplary fluids for use with the catheter include a cooling fluid, a therapeutic fluid, and a medication.

Abstract: An electrosurgical generator, a control device, a method for operating the electrosurgical generator and a computer program product. The electrosurgical generator includes an ultrasonic generator for providing an excitation signal by which an ultrasonic converter can generate an ultrasonic vibration, a radiofrequency generator for providing a radiofrequency energy at two output contacts, and a control unit adapted to independently activate the radiofrequency generator and the ultrasonic generator. The control unit is further adapted to determine a DC-offset voltage between the two output contacts of the radiofrequency generator, check if the DC-offset voltage exceeds a DC-offset threshold value, and deactivate the ultrasonic generator if the DC-offset voltage does not exceed the DC-offset threshold.

Abstract: A torque-delivering cable is provided, which includes a first coupling. The torque-delivering cable and the first coupling are shaped so as to collectively define a first passage therethrough. A tissue anchor is further provided, which includes a tissue-engaging element and a second coupling, which second coupling is shaped so as to define a second passage therethrough. The first and the second couplings are interlockingly coupleable to each other. An elongate longitudinal locking element is additionally provided, which is shaped so as to define a sharp tip, and which (a) when reversibly disposed in the first and the second passages, maintains coupling together of the first and the second couplings, and (b) when withdrawn from the second passage, allows decoupling of the first and the second coupling from each another.

Abstract: Catheters including elements configured to deliver energy to nerves at or near a treatment location within a body lumen. A treatment assembly is transformable between a low-profile delivery configuration wherein a pair of electrodes are in a staggered arrangement relative to each other along the longitudinal axis, and an expanded deployed configuration wherein the pair of electrodes is aligned along an electrode axis that is orthogonal relative to the longitudinal axis.

Abstract: An ultrasonic treatment apparatus includes a probe main body performing a vibration including a longitudinal vibration in a vibrating direction parallel to a longitudinal axis, and a distal treatment section positioned on a distal direction side with respect to a most distal node position positioned most distally among node positions of the longitudinal vibration in the probe main body. A probe side facing surface is provided in a position facing a jaw in a surface of the distal treatment section. A coating portion is made of a material having a higher heat resistance than the probe main body, and coats a surface facing a side opposite to the probe side facing surface in the probe main body.

Abstract: Limiting joint temperature. At least some of the example embodiments are systems including an electrosurgical probe and a high frequency power supply. The electrosurgical probe may include: a shaft with a distal end, a proximal end, and lumen defined within the shaft; an active electrode disposed near the distal end; a return electrode disposed on the shaft; and a temperature sensor disposed on the shaft spaced away from the active electrode and the return electrode, the temperature sensor is electrically insulated from the electrically conductive fluid. The high frequency power supply may be coupled to the active electrode, and configured to provide an electrical energy output between the active electrode and the return electrode.

Abstract: The invention provides a non-invasive treatment device (100) for heating a first (15) and a second (25) inner region of skin using r.f. electrical current, comprising: a first r.f. treatment electrode (10) configured and arranged to allow r.f. current to pass through the first inner region (15) to a return electrode (340), a second r.f. treatment electrode (20) configured and arranged to allow r.f. current to pass through the second inner region (25) to the return electrode (340), the device further being arranged such that the smallest distance between the first r.f. treatment electrode (10) and the return electrode (340) is less than the smallest distance between the second r.f. treatment electrode (20) and the return electrode (340); wherein the electrical skin contact area of the return electrode (340) is 5 or more times larger than the electrical skin contact area of the first r.f. treatment electrode (10), and the electrical skin contact area of the second r.f.

Abstract: Medical devices and methods for making and using medical devices are disclosed. An example medical device may include a catheter shaft. An expandable balloon may be coupled to the catheter shaft. The balloon may be capable of shifting between an unexpanded configuration and an expanded configuration. Electrode assemblies with electrical pathways may be coupled to the balloon. The electrical pathways may be capable of shifting between a serpentine configuration when the balloon is unexpanded to a straighter configuration when the balloon is expanded.

Abstract: A catheter and catheter system may be used to treat disease tissue by gentle heating in combination with gentle or standard dilation. An elongate flexible catheter body with a radially expandable balloon having a plurality of electrodes engage tissue including diseased tissue when the structure expands.

Abstract: In one aspect of the present disclosure, a laser fiber may include an optical fiber. The optical fiber may include a proximal portion. The optical fiber also may include a distal portion having a distal end. The optical fiber may be configured to transmit laser energy from the proximal portion to the distal portion for emission of the laser energy from the distal end. The optical fiber also may include a distal tip surrounding the distal portion to protect the distal portion. The distal tip may include a sheet glass material having a laser energy emitting surface. The laser energy emitting surface may be defined by a chemically-strengthened surface layer.

Abstract: A method, including selecting a first maximum radiofrequency (RF) power to be delivered by an electrode within a range of 70W-100W, and selecting a second maximum RF power to be delivered by the electrode within a range of 20W-60W. The method also includes selecting an allowable force on the electrode within a range of 5 g-50 g, selecting a maximum allowable temperature, of tissue to be ablated, within a range of 55° C.-65° C., and selecting an irrigation rate for providing irrigation fluid to the electrode within a range of 8-45 ml/min. The method further includes performing an ablation of tissue using the selected values by initially using the first power, switching to the second power after a predefined time between 3 s and 6 s, and terminating the ablation after a total time for the ablation between 10 s and 20 s.

Abstract: Described here are systems and methods for affecting tissue within a body to form a lesion. Some systems comprise tissue-affecting devices, devices that guide the advancement of the tissue-affecting elements to a target tissue region, devices that locate and secure tissue, and devices that help position the tissue-affecting devices along the target tissue. The methods described here comprise advancing a first tissue-affecting device to a first surface of a target tissue, advancing a second tissue-affecting device to a second surface of the target tissue, and positioning the first and second devices so that a lesion may be formed in the tissue between them. In some variations, the devices, systems, and methods described here are used to treat atrial fibrillation by ablating fibrillating tissue from an endocardial surface and an epicardial surface of a heart. Methods of closing, occluding, and/or removing the left atrial appendage are also described.

Abstract: A catheter is disclosed for creating a lesion in nerve-containing tissue spaced from a body lumen while protecting tissue forming and adjacent to a wall of the body lumen from injury. The catheter includes a catheter body having at least one fluid passage therein, a balloon in communication with the at least one fluid passage to receive cooling fluid for inflating the balloon, a microwave antenna carried by the catheter that emits microwave energy omnidirectionally, thereby heating the tissue spaced from the body lumen to a temperature sufficient to cause thermal damage while the tissue forming and adjacent to the wall of the body lumen are maintained at a temperature where thermal damage does not occur, and a tip structure located at an end of the catheter body, configured to receive a guide wire extending through the at least one fluid passage in the catheter body.

Abstract: A mapping catheter including an elongate catheter body extending from a proximal end to a distal end, a handle connected to the proximal end of the catheter body, an electrode array connected to the distal end, a deployment shaft, and an irrigation system. The catheter body includes at least one lumen. The irrigation system includes a manifold and a thin, polymeric irrigation tube. The manifold is disposed within the handle and is connectable to a source of irrigation fluid. The irrigation tube is connected to the manifold and extends around the deployment shaft from the manifold to the distal end of the catheter through the catheter body lumen. The irrigation tube forms an annular lumen between an inner surface of the irrigation tube and an outer surface of the deployment shaft. The annular lumen is configured to carry irrigation fluid from the manifold to the array.

Abstract: A cryoablation method, system, and device that allows for real-time and accurate assessment and monitoring of PV occlusion and lesion formation without the need for expensive imaging systems and without patient exposure to radiation. The system includes a cryoballoon catheter with a cryoballoon, a distal electrode, a proximal electrode, and a temperature sensor. Impedance measurements recorded by the electrodes may be used to predict ice formation, quality of pulmonary vein occlusion, and lesion formation.

Abstract: This invention provides a system and method that allows a therapeutic device, such as an atrial fibrillation microwave ablation catheter or ablation tip to be guided to a remote location within a body cavity and then accurately immobilized on the tissue, including that of a moving organ, such as the heart. In various embodiments, the system and method also enables accurate movement and steering along the tissue, while in engagement therewith. Such movement and engagement entails the use of vacuum or microneedle structures on at least two interconnected and articulated immobilizers that selectively engage to and release from the tissue to allow a crawling or traversing walking across the organ as the therapeutic catheter/tool tip applies treatment (AGE devices). In further embodiments that lack a movement capability (AID devices), the immobilizers allow a predetermined position for the introduced device to be maintained against the tissue while a treatment is applied to the location adjacent thereto.